The effect of cost sharing on the use of antibiotics in ambulatory care: Results from a population-based randomized controlled trial

Department of Medicine, University of California, Los Angeles, Los Ángeles, California, United States
Journal of Chronic Diseases 02/1987; 40(5):429-37. DOI: 10.1016/0021-9681(87)90176-7
Source: PubMed


Little is known about how generosity of insurance and population characteristics affect quantity or appropriateness of antibiotic use. Using insurance claims for antibiotics from 5765 non-elderly people who lived in six sites in the United States and were randomly assigned to insurance plans varying by level of cost-sharing, we describe how antibiotic use varies by insurance plan, diagnosis and health status, geographic area, and demographic characteristics. People with free medical care used 85% more antibiotics than those required to pay some portion of their medical bills (controlling for all other variables). Antibiotic use was significantly more common among women, the very young, patients with poorer health, and persons with higher income. Use of antibiotics for viral, viral-bacterial, and bacterial conditions did not differ between free and cost-sharing insurance plans, given antibiotics were the treatment of choice. Cost sharing reduced inappropriate and appropriate antibiotic use to a similar degree.

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    • "Other studies have considered changes in the use of discretionary medications among individuals of various ages. Data from the RAND experiment (Foxman et al., 1987), which looked at non-elderly participants across six sites in the US, indicated that individuals with higher coinsurance rates decreased their use of both effective and ineffective antibiotics. Using aggregate data from New Hampshire, Soumerai et al. (1987) determined that a limit on the number of reimbursable prescriptions, which is essentially 100% coinsurance, reduced the number of essential and discretionary medications obtained among low-income Medicaid recipients. "
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    ABSTRACT: This paper explores different empirical strategies to examine the effect of cost sharing for prescription drugs in some dimensions of medication-related quality, namely the probability of inappropriate prescription drug use among United States seniors. Using data from 1996 to 2005, we explore various specifications that correct for sample selection, endogeneity¸ and unobserved heterogeneity. We find a small, but measurable, negative price elasticity for inappropriate drug use with respect to self-reported average out-of-pocket costs for all drugs consumed. That is, user fees reduce the use of potentially inappropriate medications, however the elasticity of cost sharing is lower than that of drugs in general and the price elasticity is relatively close to zero, suggesting that any quality improvements from co-payments are small.
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    • "Despite these restrictions, Arthur A. Nelson and Mikell R. Quick (1980) and Nelson, C. Eugene Reeder, and W. Michael Dickson (1984) found that Medicaid drug copayments have significantly reduced drug utilization and expenditures. Several other studies report that drug copayments have caused reductions in the utilization of " essential " drugs (e.g., insulin) leading to subsequent increases in the use of nondrug services (Reeder and Nelson 1985; Lohr et al. 1986; Foxman, Valdez, and Lohr 1987; Manning et al. 1986; Keeler and Rolph 1983; Beck 1974). "
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    ABSTRACT: Aggregate pooled cross-sectional and time-series annual state data for 1985 to 1992 were used to estimate the systemwide effects of retrospective drug utilization review programs (Retro-DUR) on Medicaid drug and nondrug outcomes. The results provide evidence that these programs produce significant cost savings in the drug budget without spillover effects (positive or negative) in other nondrug budgets within the Medicaid system. We also examine the influence of restricted formularies in this post-Retro-DUR era on drug and nondrug budgets in the Medicaid system; we find significant cost savings in the former but positive spillover effects in the latter.
    Journal of Health Politics Policy and Law 09/2000; 25(4):653-88. · 1.37 Impact Factor
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    • "The copayment policy introduced in the UK by the NHS has led to a significant reduction in the use of prescribed drugs among non-exempt patients [32]. The result of the Rand Health Insurance Experiment showed that people with free medical care used antibiotics 85% more than those required to pay some portion of their medical bills [22]. The Rand study can be used to address price elasticity of demand for antibiotics but our study cannot. "
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    ABSTRACT: A cross-sectional study was carried out at county, township and village health care facilities in four counties in rural China in order to describe and compare the effects of health financing systems on antibiotic prescribing in outpatient care. A total of 1232 outpatients at the health care facilities was selected by multi-stage random sampling and were interviewed over 2 weeks. The results showed that health financing systems appeared to influence antibiotic prescribing in outpatient care, both in terms of frequency and of the types prescribed. The insured group had lower prescribing of antibiotics at township and village health care facilities, and for respiratory tract infections, but had higher prescribing of newer antibiotics at county and village health care facilities, for respiratory tract and g-i infections. Because there was a high patient compliance rate (94.3%) in this study the prescribing of antibiotics (supply side behavior) reflected the use of antibiotics (demand side behavior) to a great extent. Thus the results imply that antibiotics prescribing and using might be biased by the patient's health financing systems and antibiotic prescribing was the result of the interaction between physicians and patients.
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